Objectives. There are two broad, long-term objectives for this application: 1. To mitigate the hazards identified in the previously conducted proactive risk assessment (PRA) with respect to information technology (IT) related failures in the emergency department (ED) setting. 2. To improve the resilience of health IT by enhancing the ability of IT systems, and the larger sociotechnical systems in which they are embedded, to survive and return to normal operations despite challenges, expected or unexpected, with a minimum of adverse effects on patients. Specific aims: The specific aims of this project are: 1. To develop a toolkit to enable organizations to identify and rank the safety-criticality of their various information systems on a continuing basis. 2. To develop a toolkit to assist organizations in evaluating and improving their maintenance plans and procedures for safety-critical information systems. 3. To develop a toolkit to assist organizations in evaluating the safety of proposed system during acquisition. 4. To implement the tools developed in Specific Aims 1-3 in two sites participating in their development. 5. To assess the generalizability of the tools developed and refined in Specific Aims 1-4 by implementing them in one additional site having only minimal participation in their development, and evaluating their effectiveness. Methods. These aims will be approached in three phases, roughly corresponding to project years. The first phase will focus on the development of instruments and toolkits by adapting existing instruments used in the military and other high hazard industries to the health care setting. In the second phase, the tools will be implemented and piloted at alpha test sites in Jacksonville and Rochester, to assess their feasibility and resource requirements, and may undergo further modification. The third phase will involve implementation at a beta site not intimately involved in development (tentatively planned to be the VCU Health System in Richmond, VA, but subject to change at this time), and evaluation of their effect on organizational processes and decision making by comparison to a control site. PUBLIC HEALTH RELEVANCE: Information technology (IT) is widely viewed as a necessary element for improving the safety, quality, and efficiency of health care, but successful use of IT is not simple, and for every success there have been many failures. These failures are expensive not only in terms of labor and capital, but may put patients at risk, and cause organizations to be unable or unwilling to undertake sometimes necessary technological changes in the future. By developing these tools and placing them in the public domain, we hope to enhance the safety and resilience of IT systems in ambulatory health care settings, and thereby to increase the pace of successful adoption in health care organizations.